Parasitology

1. PARASITOLOGYPARASITOLOGY Protozoa and HelminthsProtozoa and Helminths Dr. Ashish V. JawarkarDr. Ashish V. Jawarkar M.D.M.D.

2. ParasitesParasites ►Organisms which are dependent on otherOrganisms which are dependent on other organisms for survivalorganisms for survival ►EukaryotesEukaryotes ►Unicellular – ProtozoaUnicellular – Protozoa ►Multicellular - HelminthsMulticellular - Helminths

3. ►Host – organism that provides nutrition toHost – organism that provides nutrition to parasiteparasite ►Definitive host – adult stage of parasite isDefinitive host – adult stage of parasite is lodged – undergoes sexual reproduction –lodged – undergoes sexual reproduction – both males and females are presentboth males and females are present ►Intermediate host – harbours larval stage ofIntermediate host – harbours larval stage of helminths, asexual reproduction of protozoahelminths, asexual reproduction of protozoa

4. For toxoplasmaFor toxoplasma

5. PROTOZOAPROTOZOA

6. ProtozoaProtozoa ►Classified according to organ of motilityClassified according to organ of motility ►Pseudopodia – amoebaPseudopodia – amoeba ►Cilia – ciliatesCilia – ciliates ►Flagella – flagellatesFlagella – flagellates ►Sporozoa (non motile)Sporozoa (non motile)

7. ► AmoebaAmoeba  E histolytica, N. fowleriE histolytica, N. fowleri ► FlagellatesFlagellates  GiardiaGiardia  T. vaginalisT. vaginalis  LeishmaniaLeishmania ► SporozoaSporozoa  PlasmodiumPlasmodium  ToxoplasmaToxoplasma ► CiliatesCiliates  B. coliB. coli

8. Classification according to site ofClassification according to site of infectioninfection ►IntestineIntestine  E histolyticaE histolytica  G. lambliaG. lamblia ►Genital tractGenital tract  T. vaginalisT. vaginalis ►BloodBlood  PlasmodiumPlasmodium  L. donovaniL. donovani

9. Entamoeba HistolyticaEntamoeba Histolytica

10. Entamoeba HistolyticaEntamoeba Histolytica ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

11. DistributionDistribution ►World wideWorld wide

12. ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

13. LocationLocation ►Parasite found in large intestineParasite found in large intestine

15. Life cycleLife cycle ►Entire life cycle completed in one host -Entire life cycle completed in one host - humanshumans

16. Morphological formsMorphological forms ►CystsCysts  Round, 10-15 micronsRound, 10-15 microns  4-6 microns nucleus4-6 microns nucleus  Highly refractile cyst wallHighly refractile cyst wall  Four or more nucleiFour or more nuclei

17. TrophozoitesTrophozoites ►18-40 microns18-40 microns ►Cytoplasm – outer ectoplasm, innerCytoplasm – outer ectoplasm, inner endoplasmendoplasm ►Nucleus – 4-6 micronsNucleus – 4-6 microns ►Ingested red blood cellsIngested red blood cells

20. Diseases causedDiseases caused ►Dysentry - Trophozoites burrow intoDysentry - Trophozoites burrow into intestinal wall and cause dysentry withintestinal wall and cause dysentry with ulcersulcers

21. ►Extra intestinal manifestationsExtra intestinal manifestations  Amebic hepatitisAmebic hepatitis  Infection of lungs/brainInfection of lungs/brain

23. Lab diagnosisLab diagnosis ►DysentryDysentry  Examine freshly passed stools or ulcerExamine freshly passed stools or ulcer scrapings for trophozoite formsscrapings for trophozoite forms  Iodine mount for cystsIodine mount for cysts ►Amoebic hepatitisAmoebic hepatitis  Liver aspirationLiver aspiration

24. ►Serological testsSerological tests  ELISAELISA  IHAIHA

26. TreatmentTreatment ►MetronidazoleMetronidazole

27. Giardia LambliaGiardia Lamblia

31. LocationLocation ►Small intestine – duodenum and upper partSmall intestine – duodenum and upper part of jejunumof jejunum

33. Life cycleLife cycle ►Entire life cycle is completed in one host -Entire life cycle is completed in one host - humanshumans

34. Morphologic formsMorphologic forms ►TrophozoiteTrophozoite  Shaped as a badminton/tennis racquetShaped as a badminton/tennis racquet  Two sucking discs on ventral surfaceTwo sucking discs on ventral surface  Bilaterally symmetricalBilaterally symmetrical  Two nuclei, two axostyles and four flagellaTwo nuclei, two axostyles and four flagella

35. ►CystCyst  Infective stageInfective stage  Egg shapedEgg shaped

38. Diseases causedDiseases caused ►steatorrhoea – excessive fat in stoolssteatorrhoea – excessive fat in stools

40. PathogenesisPathogenesis ►Steatorrhoea is due to malabsorption of fatSteatorrhoea is due to malabsorption of fat ►Disease is never invasive – no dysentryDisease is never invasive – no dysentry

42. Lab diagnosisLab diagnosis ►Demonstration of cysts and trophozoites inDemonstration of cysts and trophozoites in stoolstool

44. TreatmentTreatment ►MetronidazoleMetronidazole

45. Trichomonas VaginalisTrichomonas Vaginalis

49. LocationLocation ►Female genital tractFemale genital tract

51. Life cycleLife cycle ►Human beings are the only hostHuman beings are the only host

52. Morphological formsMorphological forms ►Only one form – trophozoiteOnly one form – trophozoite ►Pear shapedPear shaped ►Single ovoid nucleusSingle ovoid nucleus ►3-5 pairs of flagella3-5 pairs of flagella ►One axostyleOne axostyle ►One undulating mebrane formed by flagellaOne undulating mebrane formed by flagella

53. Life cycleLife cycle

55. Diseases causedDiseases caused ►Trichomoniasis in females which is aTrichomoniasis in females which is a sexually transmitted disease – presents assexually transmitted disease – presents as UTIUTI ►In males - urethritisIn males - urethritis

57. Lab diagnosisLab diagnosis ►Demonstrate organism in vaginal dischargeDemonstrate organism in vaginal discharge from females and urethral discharge fromfrom females and urethral discharge from malesmales ►Saline preparation shows characteristicSaline preparation shows characteristic corkscrew motilitycorkscrew motility  Please see the linkPlease see the link https://www.youtube.com/watch?v=9B1PFJXuJUshttps://www.youtube.com/watch?v=9B1PFJXuJUs for motilityfor motility

59. TreatmentTreatment ►Metronidazole to both partnersMetronidazole to both partners

60. HAEMOFLAGELLATESHAEMOFLAGELLATES LeishmaniaLeishmania PlasmodiaPlasmodia

61. Leishmania DonovaniLeishmania Donovani

63. DistributionDistribution ►India - endemicIndia - endemic

65. LocationLocation ►Reticuloendothelial systemReticuloendothelial system  Bone marrowBone marrow  LiverLiver  SpleenSpleen

67. Life cycleLife cycle ►Two hostsTwo hosts  Humans – definitive host (sexual reproduction)Humans – definitive host (sexual reproduction)  Sandfly – intermediate host (asexualSandfly – intermediate host (asexual reproduction)reproduction)

68. Morphologic formsMorphologic forms ► Promastigote stage –Promastigote stage –  Stage with flagellaStage with flagella  Nucleus in centreNucleus in centre  One kinetoplast at anterior endOne kinetoplast at anterior end  Flagella at anterior endFlagella at anterior end ► Amastigote stage –Amastigote stage –  Seen in humansSeen in humans  Egg shapedEgg shaped  Nucleus at centreNucleus at centre  Kinetoplast at right angleKinetoplast at right angle

71. Diseases causedDiseases caused ►Kala Azar a/k/a Visceral LeishmaniasisKala Azar a/k/a Visceral Leishmaniasis ►Fever with enlargement of spleen,Fever with enlargement of spleen, lymphnodeslymphnodes

72. ►Misdiagnosed as malariaMisdiagnosed as malaria

74. PathogenesisPathogenesis ►Affects immune systemAffects immune system ►Complications due to oppurtunisticComplications due to oppurtunistic infectionsinfections

76. Lab diagnosisLab diagnosis ►DirectDirect  Demonstration of LD body in bone marrowDemonstration of LD body in bone marrow smearssmears  Culture in NNN mediumCulture in NNN medium ►IndirectIndirect  Indirect Haemagglutination testIndirect Haemagglutination test  ELISAELISA

79. TreatmentTreatment ►Amphotericin BAmphotericin B

80. SPOROZOASPOROZOA PlasmodiumPlasmodium

81. MalariaMalaria ► Sporozoite – no special organs of locomotionSporozoite – no special organs of locomotion ► Mal-air = Bad airMal-air = Bad air ► Plasmodium discovered by Sir Ronald Ross inPlasmodium discovered by Sir Ronald Ross in Secunderabad, APSecunderabad, AP ► Four speciesFour species  P. vivaxP. vivax  P. falciparumP. falciparum  P. ovaleP. ovale  P. malariaeP. malariae

83. DistributionDistribution

85. LocationLocation ►Liver cellsLiver cells ►Red Blood cellsRed Blood cells

86. Life cycleLife cycle ►Definitive host – Female anophelesDefinitive host – Female anopheles mosquitomosquito ►Intermediate host – HumansIntermediate host – Humans

89. Pre erythrocytic schizogony Erythrocytic schizogony Gametogony

90. Morphological formsMorphological forms ►Pre erythrocytic schizogony – sporozoitesPre erythrocytic schizogony – sporozoites ►Erythrocytic schizogony – trophozoite,Erythrocytic schizogony – trophozoite, schizont and merozoiteschizont and merozoite ►Gametogony – gamets (micro and macro)Gametogony – gamets (micro and macro) ►Mosquito – ookinete, oocyst, sporozoiteMosquito – ookinete, oocyst, sporozoite

91. Morphologic formsMorphologic forms ►schizontsschizonts

92. Ring forms (trophozoites)Ring forms (trophozoites)

93. gametocytegametocyte

96. Disease causedDisease caused ► MalariaMalaria ► Fever with chills – co incides with release ofFever with chills – co incides with release of parasites in bloodparasites in blood ► SplenomegalySplenomegaly ► Hemolytic anemiaHemolytic anemia ► Black water fever – intravascular hemolysisBlack water fever – intravascular hemolysis ► Pernicious malaria – in P. falciparumPernicious malaria – in P. falciparum  Cerebral malaria – brain capillaries clogged withCerebral malaria – brain capillaries clogged with parasitesparasites  Algid malaria – liver failureAlgid malaria – liver failure  septicemiasepticemia

98. PathogenesisPathogenesis ►Due to release of parasites in blood –Due to release of parasites in blood – cytokines are released which cause fevercytokines are released which cause fever and chillsand chills ►Hemolytic anemiaHemolytic anemia

100. Lab diagnosisLab diagnosis ►Examine blood smears for ringExamine blood smears for ring forms/schizontsforms/schizonts ►Antigen detection testsAntigen detection tests

102. TreatmentTreatment ►ChloroquineChloroquine ►ArtimesinArtimesin ►MefloquineMefloquine ►PrimaquinePrimaquine

103. HELMINTHSHELMINTHS

104. HelminthsHelminths ►Commonly called – ‘worms’Commonly called – ‘worms’ ►Three groupsThree groups  Nematodes – unsegmented bodyNematodes – unsegmented body  Cestodes – segmented body – tape likeCestodes – segmented body – tape like  Trematodes – leaf like - flukesTrematodes – leaf like - flukes

106. ► NematodesNematodes  Round wormRound worm  Hook wormHook worm  Thread worm/pin wormThread worm/pin worm  Filarial wormsFilarial worms ► CestodesCestodes  T. saginata – Beef tape wormT. saginata – Beef tape worm  T. solium – pork tape wormT. solium – pork tape worm  E. granulosus – Dog tape wormE. granulosus – Dog tape worm ► TrematodesTrematodes  Intestinal flukes -Intestinal flukes -  Liver flukes – C. sinensis, f. hepaticaLiver flukes – C. sinensis, f. hepatica  Lung flukes – P. westermaniiLung flukes – P. westermanii  Blood flukes – S. hematobiumBlood flukes – S. hematobium

107. Round wormRound worm (Ascaris Lumbricoides)(Ascaris Lumbricoides) ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

110. LocationLocation ►Small intestine (jejunum)Small intestine (jejunum)

112. Life cycleLife cycle ►Humans are the only hostsHumans are the only hosts

113. Morphologic formsMorphologic forms ►Adult wormsAdult worms  Resemble earth wormsResemble earth worms  Male – female separateMale – female separate  2.5 to 4 cm in length, 5 mm in diameter2.5 to 4 cm in length, 5 mm in diameter  Female worm lays 2.5 lakh eggs every day!!!!!Female worm lays 2.5 lakh eggs every day!!!!!

114. Morphological formsMorphological forms ►EggsEggs  Bile stainedBile stained  Fertilised/unfertilisedFertilised/unfertilised  Single unsegmented ovum with clearSingle unsegmented ovum with clear crescenteric areascrescenteric areas

117. Diseases causedDiseases caused ►Malabsorption of nutrientsMalabsorption of nutrients ►CoughCough ►Intestinal obstructionIntestinal obstruction

119. Lab diagnosisLab diagnosis ►Stool examinationStool examination  eggseggs

121. TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole

122. Hook wormHook worm (Ancylostoma Duodenale /(Ancylostoma Duodenale / Necator Americanus)Necator Americanus)

124. DistributionDistribution ►World wideWorld wide ►Tropical and subtropical countriesTropical and subtropical countries

126. LocationLocation ►Small intestine, mainly jejunumSmall intestine, mainly jejunum

128. Life cycleLife cycle ►Only one host - humansOnly one host - humans

130. Morphologic formsMorphologic forms ►EggsEggs  Not bile stainedNot bile stained

131. Adult wormsAdult worms ►1-2 cm1-2 cm ►CylindricalCylindrical ►Anterior end is bent – hook likeAnterior end is bent – hook like

133. Diseases causedDiseases caused ►Iron deficiency anemia due to chronic bloodIron deficiency anemia due to chronic blood lossloss

134. ►Itch at the site of entry into the skinItch at the site of entry into the skin ►Cutaneous larva migransCutaneous larva migrans

136. Lab diagnosisLab diagnosis ►Stool – look for eggsStool – look for eggs ►Indirect –Indirect –  Iron deficiency anemia on PSIron deficiency anemia on PS  Stool – occult bloodStool – occult blood  EosinophiliaEosinophilia

138. TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole ►PyrantelPyrantel

139. Thread worm / Pin wormThread worm / Pin worm (Enterobius Vermicularis)(Enterobius Vermicularis)

143. LocationLocation ►Large intestine – cecum and appendixLarge intestine – cecum and appendix

145. Life cycleLife cycle ►Humans are the only hostHumans are the only host

147. Morphologic formsMorphologic forms ►EggsEggs

148. ►Adult wormsAdult worms

150. Diseases causedDiseases caused ►Pruritis aniPruritis ani ►Nocturnal enuresisNocturnal enuresis

152. Lab diagnosisLab diagnosis ►NIH swab (National institute of health) forNIH swab (National institute of health) for demonstrating eggsdemonstrating eggs ►Demonstration of adult worms in stoolDemonstration of adult worms in stool

154. TreatmentTreatment ►AlbendazoleAlbendazole ►MebendazoleMebendazole ►PyrantelPyrantel

155. FILARIASISFILARIASIS (W. bancroftii, B. malayii)(W. bancroftii, B. malayii)

157. DistributionDistribution ►World wide – including IndiaWorld wide – including India

159. LocationLocation ►Adult worm – lymphaticsAdult worm – lymphatics ►Microfilaria - bloodMicrofilaria - blood

161. Life cycleLife cycle ►Humans – definitive hostHumans – definitive host ►Culex/anopheles/aedes mosquito –Culex/anopheles/aedes mosquito – intermediate hostintermediate host

163. Morphological formsMorphological forms ►Adult wormAdult worm  Female – 10 cmFemale – 10 cm  Male – shorterMale – shorter  Lay eggs containing embryo (microfilaria)Lay eggs containing embryo (microfilaria)

164. ►MicrofilariaMicrofilaria  290 microns290 microns  Present in peripheral bloodPresent in peripheral blood

166. ElephantiasisElephantiasis ►Adult worm causes blockage of lymphaticAdult worm causes blockage of lymphatic channelschannels

168. Lab diagnosisLab diagnosis ►Microfilaria demonstrationMicrofilaria demonstration  Parasites seen in blood between 10 pm and 2Parasites seen in blood between 10 pm and 2 amam  Co incides with feeding time of mosquitoesCo incides with feeding time of mosquitoes

169. ►Adult worm demonstrationAdult worm demonstration  Lymphnode biopsyLymphnode biopsy

171. TreatmentTreatment ►DEC (Diethylcarbamazine) helps treatDEC (Diethylcarbamazine) helps treat filariasisfilariasis ►But elephantiasis once developed cannot beBut elephantiasis once developed cannot be curedcured

172. CestodesCestodes Taenia SaginataTaenia Saginata Taenia SoliumTaenia Solium E. GranulosusE. Granulosus

173. Taenia Saginata/Taenia soliumTaenia Saginata/Taenia solium (beef tapeworm/pork tape worm)(beef tapeworm/pork tape worm) ►DistributionDistribution ►LocationLocation ►Life cycleLife cycle ►Diseases causedDiseases caused ►PathogenesisPathogenesis ►Lab diagnosisLab diagnosis ►TreatmentTreatment

174. DistributionDistribution ►SaginataSaginata ►World wide in beef eating populationWorld wide in beef eating population  Not seen in India in regions where beef is notNot seen in India in regions where beef is not eateneaten ►SoliumSolium  World wide in pork eating populationWorld wide in pork eating population

176. LocationLocation ►Small intestineSmall intestine

178. Life cycleLife cycle ►SaginataSaginata  Definitive host – humansDefinitive host – humans  Intermediate host – cows and buffalosIntermediate host – cows and buffalos ►SoliumSolium  Definitive host – humansDefinitive host – humans  Intermediate hosts - pigsIntermediate hosts - pigs

179. Morphological formsMorphological forms ►Adult worm (saginata)Adult worm (saginata)  Inside humansInside humans  Segmented – called proglottids – contain eggs –Segmented – called proglottids – contain eggs – passed in fecespassed in feces

180. Morphological formsMorphological forms ►Adult worm – soliumAdult worm – solium  Similar except for additional rostellum / hookletsSimilar except for additional rostellum / hooklets

181. ►Eggs (same for both)Eggs (same for both)  Spherical and bile stainedSpherical and bile stained

182. Life cycleLife cycle CYSTICERCU S

184. Diseases causedDiseases caused ►Disease is asymptomatic and remainsDisease is asymptomatic and remains undiagnosedundiagnosed ►Problem is that humans may act asProblem is that humans may act as occasional intermediate hosts in case of T.occasional intermediate hosts in case of T. soliumsolium  Called cysticercosisCalled cysticercosis  Patients present with seizures/convulsionsPatients present with seizures/convulsions

187. Lab diagnosisLab diagnosis ►Not really possible!!Not really possible!! ►Unless there is cysticercosisUnless there is cysticercosis  CT SCANCT SCAN  BiopsyBiopsy

189. TreatmentTreatment ►MepacrineMepacrine

190. Echinococcus GranulosusEchinococcus Granulosus (Dog tape worm)(Dog tape worm)

192. DistributionDistribution ►World wideWorld wide ►Where sheep and cattle are bredWhere sheep and cattle are bred ►There must be a close association betweenThere must be a close association between humans, sheep and dogshumans, sheep and dogs

194. LocationLocation ►LiverLiver ►LungsLungs ►Wherever embryos settleWherever embryos settle

196. Life cycleLife cycle ►Dog is definitive hostDog is definitive host ►Sheep are intermediate hostsSheep are intermediate hosts ►Humans are accidental intermediate hostsHumans are accidental intermediate hosts

197. Morphological formsMorphological forms ►Adult wormAdult worm  Inside definitive hostsInside definitive hosts  Has head, neck and stobilaHas head, neck and stobila  Has 4 segmentsHas 4 segments  Head has suckers (rostellum)Head has suckers (rostellum)

198. ►EggsEggs  Indistinguishable from T. saginata/soliumIndistinguishable from T. saginata/solium

199. ►Larva (hydatid cyst)Larva (hydatid cyst)

202. Diseases causedDiseases caused ►Hydatid cyst can remain undetected forHydatid cyst can remain undetected for many yearsmany years ►It causes symptoms depending on theIt causes symptoms depending on the organ in which it has formedorgan in which it has formed ►Rupture of cyst can cause anaphylacticRupture of cyst can cause anaphylactic shockshock

204. Lab diagnosisLab diagnosis ►Casoni’s testCasoni’s test ►EosinophiliaEosinophilia ►Serological testsSerological tests ►Examination of cyst fluidExamination of cyst fluid ►CT scan, USG, X rayCT scan, USG, X ray

206. TreatmentTreatment ►Surgical removal without ruptureSurgical removal without rupture

207. TREMATODESTREMATODES ►Least commonly reported in IndiaLeast commonly reported in India ►Refer to examples at the starting of thisRefer to examples at the starting of this lecturelecture ►Detailed discussion is beyond the scope ofDetailed discussion is beyond the scope of this lecturethis lecture

208. Thanks !!!Thanks !!! ►LIKE THIS LECTURE!!!!LIKE THIS LECTURE!!!!

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